Skin Cancer (Mohs) #53

A case showing a composite skin/fat graft for repair of a central ala defect following Mohs.  A normal skin graft does well on the upper nose but does not provide a good color or texture match on the lower nose or ala.  In these areas on the ala and nasal tip, if there is still enough underlying support that a cartilage graft is not needed, a Skin/Fat composite graft can give a good result and reduce the need for more complex flap repairs.  This is a case of a woman in her late 60s who is shown immediately after Moh’s excision of a basal cell carcinoma of her right ala, and then 1, 3, and 4 weeks after placement of the composite graft.  These grafts typically form a scab on the surface and don’t appear to be “working”.  But they adhere, the deep layers take and the scab is not debrided and left to come off spontaneously on its own at 6 weeks or more.  She is shown again at 5 months with an excellent result.